CDDN/DDC RENEWAL APPLICATION

Transcription

1 CDDN/DDC RENEWAL APPLICATION GUIDELINES Yur respnsibilities: It is yur respnsibility t actively maintain yur CDDN r DDC certificatin, which includes awareness f the expiratin date, gathering and cmpleting the renewal applicatin, and ntifying DDNA f any changes t yur preferred cntact infrmatin. Failure t receive renewal reminders des nt relieve yu f the respnsibility t apply fr certificatin renewal in a timely manner. The expiratin date is n yur certificatin card and n yur certificate. If yu are unable t determine yur expiratin date, yu may DDNA at certificatin@ddna.rg. Yu must maintain active membership in DDNA thrughut the entire certificatin perid. Perid f validity: Once renewed, certificatin is valid fr tw years. If yur renewal applicatin is nt pstmarked by the certificatin expiratin date, yur certificatin status is cnsidered inactive and any petitin t reinstate it will be gverned by existing DDNA guidelines. This may require yu t re-enter the certificatin prcess as a new candidate and successfully cmplete all steps required f a new candidate. Steps include submitting a new applicatin, payment f all applicable fees, and retaking the certificatin examinatin with a passing scre. Once yur certificatin has becme inactive, yu may nt use the CDDN r DDC credential as part f yur prfessinal signature. Dcumentatin: All dcumentatin submitted is subject t verificatin and becmes the prperty f DDNA. Fees: All fees are nn-refundable. Payment f applicatin fees des nt guarantee that yur renewal will be apprved. Recgnitin f certificatin: Certificatin is vluntary. N gvernmental r ther regulatry entity currently requires certificatin. Any value r credence given t certificatin by an agency, emplyer, r third-party insurer is entirely at its discretin. Such value r credence shuld be based upn knwledge f the certificatin standards and experience with CDDNs and DDCs. Nurses seeking certificatin chse t d s f their wn free will and, in ding s, agree t accept the decisins f DDNA. The authrity f DDNA is derived frm thse persns wh are dedicated t service as practicing I/DD nurses and are, as such, thse wh are mst affected by certificatin. Credibility f certificatin: The credibility f certificatin results frm the standards established by DDNA, the perfrmance f the DDNA Bard f Directrs, Officers, and Certificatin Cmmittee, and mst imprtantly, the prfessinal cmpetence and integrity f the Certified Develpmental Disabilities Nurse r the Develpmental Disabilities Certified Licensed Practical Nurse r Licensed Vcatinal Nurse. The rle f DDNA: Althugh DDNA encurages and prmtes the wrk f ther prfessinal assciatins and ther rganizatins invlved in the varius facets f prviding services t peple with I/DD, it is an independent bdy and seeks t remain free frm any vested interest. APPLICANT CHECKLIST The fllwing frms, dcumentatin, and fees are required fr the applicatin: Frm A Applicant Infrmatin Cpy f Nursing License A phtcpy f yur current nursing license n standard 8½ x 11 paper, marked vid. D nt cut ut the license. Yu may als print ut a cpy f yur license r license verificatin frm yur state s licensing website. Expiratin date must be displayed n cpy/print ut. Frm B DDNA Cde f Ethics Agreement riginal dcument required, n cpies permitted. Frm C Emplyment Verificatin riginal dcument required, n cpies permitted. A separate frm must be submitted fr each place f emplyment, specific t I/DD nursing, that ccurred within the tw-year certificatin renewal perid. Fr independent practitiners: The Certificatin Cmmittee has develped an alternative prcess t determine the validity and duratin f wrk experience fr independent practitiners, such as business wners, cnsultants, and direct care cntractrs. The Emplyment Verificatin frm (Frm C) must be cmpleted and may be signed by a business partner, the representative f an agency t whm the applicant is cntracted, r any prfessinal wh is in a psitin t verify the wrk invlvement f the applicant. The applicant may sign her r his wn jb verificatin frm nly if the dcumentatin f the hurs wrked is substantiated by cntracts r service invices, and the party affiliated with the cntracts and/r invices is nt available t sign the Emplyment Verificatin frm. Jb descriptin(s) T accmpany Frm C. The jb descriptin must be written by the emplyer. Each psitin dcumented must be specific t I/DD nursing. List each psitin, perid f emplyment, and/r facility. If the jb descriptin is nt I/DD specific, then an addendum written n facility letterhead and signed by a supervisr is required. Fr independent practitiners: Fr independent practitiners, the Cmmittee will accept a jb descriptin, designed and signed by the applicant, if it includes specifically the develpmental disabilities aspect f the wrk respnsibility. Frm D Cntinuing Educatin Summary See the Educatin Requirement fr specific guidelines. Include crrespnding certificates r transcripts Brchure r prgram utline T accmpany Frm C. Prvide a brchure r prgram descriptin, r printed website cntent, fr each facility and prgram dcumented n the emplyment verificatin frm(s). Cpy f yur current curriculum vitae, resume, r bi sketch Renewal fee see next page fr fee schedule. CDDN/DDC Renewal Applicatin (rev. 07/2017)

2 CDDN/DDC RENEWAL APPLICATION INSTRUCTIONS 1. Befre cmpleting yur renewal applicatin packet, review the Guidelines, the Instructins, and all f the required frms (Frms A, B, C, and D) and dcumentatin listed in the Checklist. 2. Read each frm carefully fr instructins. Only riginal signatures will be accepted d nt submit cpies f signed frms. Type r neatly print the requested infrmatin n the frms. Dcumentatin that is altered in any way (whiteut used, infrmatin crssed ut, etc.) r is illegible will nt be accepted. It is yur respnsibility t check yur applicatin packet fr accuracy and cmpleteness befre submitting it t the DDNA Certificatin Cmmittee fr review. The certificatin credential is a reflectin f yur prfessinal dedicatin. The renewal applicatin packet shuld reflect the same prfessinalism. 3. Submit all required frms, dcumentatin, and fees as part f the applicatin packet. The Certificatin Cmmittee and DDNA will nt initiate transfer f infrmatin frm ther surces. Omissin f any required item in the certificatin applicatin will delay the prcessing f yur applicatin. 4. Include nly ne renewal applicatin per envelpe. D nt staple r tape the frms tgether. All dcuments submitted shuld be n standard 8½ x 11 paper. Include nly the items listed n the Checklist. It is nt necessary t include printuts f the certificatin instructins. Ding s will increase the weight f the package and will increase yur pstage expense. 5. When mailing yur renewal applicatin packet, please remember that these packets are cnsidered versized and require additinal pstage. Please have them weighed at the pst ffice befre mailing. If yur applicatin packet arrives at the DDNA pst ffice bx with pstage due, it will be returned t yu by the pst ffice fr crrect pstage. We appreciate yur taking the time t make sure that yur pstage is crrect. 6. Please allw a minimum f 60 days fr the prcessing f the renewal applicatin nce it is received at the DDNA ffice. Yu will be ntified f the utcme f the review. 7. Mail yur cmpleted renewal applicatin packet t: DDNA Certificatin, 1501 Suth Lp 288, Suite , Dentn, TX If yu need help r wuld like further clarificatin f the abve instructins, please call DDNA at (800) r certificatin@ddna.rg. CDDN/DDC Renewal Applicatin (rev. 07/2017) APPROVAL PROCESS Within 60 days f receiving yur applicatin packet, DDNA will ntify yu whether yur applicatin is apprved r deficient. Be sure t include yur crrect address and phne number n the applicatin frms, as this will be used t cntact yu. If yur renewal applicatin is deficient: Yu will be ntified by and given the pprtunity t crrect the deficiency. Cmmn causes f a deficient applicatin include: insufficient CE, wrk experience nt specific t I/DD nursing, insufficient wrk experience, illegible frms, frms that are faxed rather than mailed, failure t prvide supervisr s riginal signature, failure t calculate and prvide ttal hurs wrked, lapsed DDNA membership, and inaccurate/missing cntact infrmatin. If yur renewal applicatin is apprved: Once apprved, yu will be ed a letter f apprval, a new certificatin ecard, and ecertificate. CERTIFICATION RENEWAL FEE SCHEDULE DDNA member in gd standing with renewal submitted prir t expiratin date $100 Renewal Applicatin Prcessing Fee (due with applicatin) This fee is fr active members. It des nt include membership dues. Please check yur membership status befre submitting fees. Must be paid by check r mney rder. Renewal Late Fee when renewal is pstmarked after expiratin date $50 Late Renewal with expired membership (n mre than 1 year past the expiratin date) $250 Renewal Applicatin Prcessing Fee (due with applicatin) This amunt includes reinstatement f yur membership fr ne year, a reactivatin fee, and the certificatin renewal applicatin prcessing fee ($100+$50+$100). Must be paid by check r mney rder.

3 CDDN/DDC RENEWAL APPLICATION ELIGIBILITY REQUIREMENTS IDD nursing certificatin is fr nurses specializing in the nursing care and supprt f persns with intellectual and develpmental disabilities. The certificatin demnstrates that a nurse has extensive experience and a high-degree f expertise in the field f IDD nursing. The nurse demnstrates this enhanced cmpetence by actively practicing in the specialty f IDD nursing and by cmpleting cntinuing educatin specific t the field f IDD nursing. Active IDD Nursing Practice is defined as the perfrmance f nursing care tasks fr the benefit f persns with intellectual and develpmental disabilities, in which at least 50% f the individuals supprted have an intellectual r develpmental disability. Examples f active IDD nursing practice include: prviding direct nursing care t individuals with IDD in residential r cmmunity settings; prviding nursing supprt as a nurse administratr, educatr, cnsultant fr prgrams prviding care t individuals with IDD; prviding care t individuals with IDD as an advanced practice nurse in residential r cmmunity settings. Nurses wrking in ther rles r settings may als meet the active IDD nursing practice requirement and will be cnsidered n a case-by-case basis. Nte: Caring fr a family member with IDD in the hme, whether paid r unpaid, des nt meet the Active IDD Nursing Practice definitin. Als, prviding cmpanin care (e.g. fster care ) t a persn(s) with IDD in the hme, whether paid r unpaid, des nt meet the Active IDD Nursing Practice definitin. Fr nurses wrking in settings where less than 100% f the clientele have IDD: The number f active IDD Nursing Practice hurs shall be based n the percentage f clients with IDD served in the nurse s wrk setting. As an example Fr nurses wrking in a full-time capacity f 2,080 hurs per year: 100% f clientele have IDD à 2,080 hurs f active IDD Nursing Practice per year à 4,160 hurs per certificatin perid 50% f clientele have IDD à 1,040 hurs f active IDD Nursing Practice per year à 2,080 hurs per certificatin perid 25% f clientele have IDD à 520 hurs f active IDD Nursing Practice per year à 1040 hurs per certificatin perid 10% f clientele have IDD à 208 hurs f active IDD Nursing Practice per year à 416 hurs per certificatin perid Certificatin in IDD nursing indicates a high-degree f expertise and cmpetence in the specialty f IDD nursing. The certified IDD nurse demnstrates this cntinued cmpetence thrugh active nursing practice in the specialty f IDD nursing and the cmpletin f current cntinuing educatin in the specialty f IDD nursing. The minimum practice and educatin eligibility requirements fr certificatin renewal are: Optin 1 1. Minimum f ne thusand (1,000) hurs f active IDD nursing practice within the tw-year perid frm date f current certificatin apprval; and a 2. Minimum f 25 cntact hurs f cntinuing educatin specific t I/DD nursing within the tw-year perid frm date f current certificatin apprval. Optin 2 1. Minimum f hurs f active IDD nursing practice within the tw-year perid frm date f current certificatin apprval; and a 2. Minimum f 40 cntact hurs f cntinuing educatin specific t I/DD nursing within the tw-year perid frm date f current certificatin apprval. Optin 3 1. If less than 500 hurs f active IDD nursing practice r n active IDD nursing practice within the tw-year perid frm date f current certificatin apprval; then a 2. Minimum f 60 cntact hurs f cntinuing educatin specific t I/DD nursing within the tw-year perid frm date f current certificatin apprval. CDDN/DDC Renewal Applicatin (rev. 07/2017)

4 CDDN/DDC RENEWAL APPLICATION EDUCATION REQUIREMENT The Educatin Requirement is satisfied by accruing cntact hurs f cntinuing educatin specific t I/DD. Only I/DD-specific cursewrk will be accepted. Educatinal fferings nt specifically addressing I/DD issues will be reviewed by the DDNA Certificatin Cmmittee fr apprpriateness. Curse dcumentatin such as utlines and/r a syllabus will help the cmmittee t evaluate material and facilitate the review prcess. Acceptable I/DD-specific curse tpics Examples include: Syndrmes and cnditins, epilepsy and seizure disrders, dual diagnsis, assessment innvatins, ethics in I/DD, AIDS and the cnsumer with I/DD, nutritin specific t I/DD, early interventin, aging and the cnsumer with I/DD, attentin deficit/hyperactivity disrder, autism spectrum disrders, issues in I/DD nursing, and ther I/DD-specific cursewrk. Acceptable related curse tpics A maximum f ten (10) hurs f IDD-related curse wrk will be accepted tward the educatin requirement. Examples f related tpics include: Alzheimer s disease, end-f-life care, medicatin administratin, psychlgy curses, anger management, sexual abuse, crisis interventin, and ther I/DD-related curse wrk. Unacceptable curse wrk Certificatin renewal in the specialty f I/DD nursing requires curse wrk that demnstrates its specificity t I/DD nursing. While many curses enhance general nursing practice, their lack f an I/DD-specific fcus prevents them frm being acceptable fr certificatin renewal. Examples f such curses are HIPAA and CPR training, general chemistry r bilgy, statistics, persnal grwth, time management, prductivity, general management, venipuncture, first aid, dmestic vilence, biterrrism preparedness, nursing and malpractice/legal issues, and ther general cursewrk. DDNA als des accept certain hme study curses. T determine whether apprval can be granted fr the hme study curse yu are cnsidering, DDNA at certificatin@ddna.rg. Nn-traditinal learning Nn-traditinal learning, such as bks, films, videtapes, telecnferences, webinars, etc. have nt been accepted by DDNA in the past tward the educatin requirement. DDNA recgnizes that the delivery f educatin is cntinually changing and nw will cnsider certain ther types f educatinal activities. All nn-traditinal learning MUST be preapprved by DDNA and MUST be specific t I/DD nursing. Preapprval requires that the applicant cmplete a required educatin verificatin cmpnent, e.g., writing a bk r film review fr the DDNA newsletter r jurnal. Cntact DDNA by at certificatin@ddna.rg fr this preapprval. Hw t earn cntinuing educatin (CE) credit Attend wrkshps, seminars, and cnferences ffering acceptable cursewrk, as utlined in this sectin n educatin requirements. Dcument attendance with cpies f cntinuing educatin credit certificates r transcripts. The attendance certificate must include the participant s name, event date, event title, event lcatin, CE apprval statement as prvided by a recgnized cntinuing educatin reviewer, and number f CE hurs. Participate in emplyer ffered/authrized, frmal in-service training designed t enhance prfessinal skills. This des nt include rutine cnsultatin, staffing r clinical supervisin training. Only specific I/DD-related training qualifies. Acceptable verificatin f this educatin credit requires submissin f a cpy f an fficial in-service recrd, highlighting the apprpriate training. The recrd must include the date, time, length f training, name f instructr/presenter, and be signed by yur supervisr fr validatin. A cpy f this recrd must be included with the Cntinuing Educatin Summary (Frm D). CDDN/DDC Renewal Applicatin (rev. 07/2017)

5 FORM A Renewal Applicant Infrmatin Please type r print neatly Name (First, MI, Last): Preferred Mailing Address: City: State: Zip: Preferred Phne: Preferred *: *We will cntact yu at this address fr any renewal matters. Emplyer: Unit: Wrk Mailing Address: City: State: Zip: DDNA Membership N.: Expiratin Date: DDNA Certificatin N.: Expiratin Date: (Check all that apply) Emplyment: Full-time Part-time Licensure: RN LPN/LVN Ø Credentials - Please print r type clearly n the line belw, as they will appear n yur certificate exactly as they are listed. (e.g. Stacey R. Smith, BSN, RN, CDDN ) (Check all that apply) Ppulatin served: Practice setting: Birth t three Early interventin prgram Pre-schl age Day treatment prgram Schl age Residential prgram Adult Wrkshp Geriatric Cnsultant Other Other Fr DDNA Office Use Only Frm A Applicant Infrmatin Applicatin Fee Membership: Expiratin Date Nursing License: Expiratin Date Frm B Ethics Statement Frm C Emplyment Verificatin **Wrks as an I/DD nurse Renewal: 1,000 hurs in 2 years* Frm D CE List 25 hurs* CE Certificates Nursing CE s in I/DD Jb Descriptin I/DD Nursing Emplyer Inf I/DD Specific Resume/CV Renewed Thrugh: Ntes: CDDN/DDC Renewal Applicatin (rev. 02/2018)

6 FORM B DDNA Cde f Ethics Original dcument required n cpies, scans, r faxes The nurse wh practices with a specialty in develpmental disabilities: Ø Cntributes significantly t the services prvided t individuals with a develpmental disability with respect fr the uniqueness f the individual and human dignity; Ø Accepts respnsibility fr develping expertise in develpmental disabilities nursing practice thrugh self-develpment and cntinuing educatin; Ø Recgnizes the rights f individuals with a develpmental disability, acts as an advcate, and strives t ensure that the rights are prtected; Ø Prmtes and maintains a safe envirnment which enhances the physical, emtinal, and spiritual wellbeing f the individual; Ø Maintains cnfidentiality at all levels in accrdance with prfessinal standards f practice, agency guidelines, and state and federal law; Ø Makes cntributins frm the nursing perspective, while recgnizing the cllabrative nature and unique rle f the interdisciplinary team in prviding quality services fr individuals with develpmental disabilities; Ø Cmmits t making cntributins t the develpment f innvative ideas fr nursing practice in the field f develpmental disabilities; Ø Serves as a resurce t prepare ther team members, including direct supprt prfessinals, t prvide quality health supprts t peple with develpmental disabilities. I am aware f my prfessinal respnsibility t maintain apprpriate cnduct thrughut my nursing practice. I agree t strive t abide by the abve cde f ethics while prviding nursing services t individuals with develpmental disabilities. Signature: Date: Nursing License Number: State: CDDN/DDC Renewal Applicatin (rev. 02/2018)

7 FORM C Emplyment Verificatin Original dcument required n cpies, scans, r faxes Applicant s Name: Name f Agency/Emplyer: Emplyer Website Address: Applicant s Jb Title: Applicant s Certificatin Perid Start Date: Expiratin Date: The fllwing t be cmpleted by the applicant s supervisr: In the psitin listed, the applicant prvided nursing care during the abve certificatin perid, t clientele in which the fllwing percentage f individuals have intellectual r develpmental disabilities: 100% 50% r mre 25% r mre 10% r mre Other: Dates f Emplyment r Cntract: Frm T Ttal number f hurs wrked by the applicant during the abve-listed tw-year certificatin perid (written abve). Hurs (must be calculated): I affirm that the infrmatin n this frm is true and crrect t the best f my knwledge. Supervisr s signature: Supervisr s name (printed): Psitin/Title: Cmpany/Unit/Prgram: Address: City: State: Zip: Phne: Signature Date: Instructins: 1. Submit ne cmpleted emplyment verificatin frm and jb descriptin fr each psitin, perid emplyment, and/r facility/prgram. NOTE: full time emplyment = 2080 hurs per year. 2. Official jb descriptins must accmpany this frm and be specific t Develpment Disabilities Nursing practice. Generic jb descriptins are nt acceptable. 3. Verificatin that facility/agency prvides services t individuals with I/DD. Please include a brchure, prgram utline, printed website cntent r descriptin f the agency r facility. 4. D nt submit frms with altered dates r hurs. 5. Originals f cmpleted frms must be submitted; n cpies, scans, r faxes. 6. Only riginal signatures will be accepted. CDDN/DDC Renewal Applicatin (rev. 02/2018)

8 FORM D Cntinuing Educatin Summary Intellectual/Develpmental Disabilities Cntinuing Educatin Summary Date Curse Title Is curse IDD specific?* Hurs Cpies f certificates, transcripts, and/r ther dcumentatin must accmpany this summary. T cmpute cntact hurs frm IDD-specific cllege curses: 1 cllege semester credit = 15 cntact hurs 1 cllege quarter credit = 10 cntact hurs TOTAL HOURS * Fr infrmatin n IDD-specific curses, visit CDDN/DDC Renewal Applicatin (rev. 02/2018)